A Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine

Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn. Electronic address: .
The American journal of medicine (Impact Factor: 5). 01/2013; 126(1):74.e11-7. DOI: 10.1016/j.amjmed.2012.07.005
Source: PubMed


To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.
We conducted a 24-week randomized clinical trial in 141 opioid-dependent patients in a primary care clinic. Patients were randomized to physician management or physician management plus cognitive behavioral therapy. Physician management was brief, manual guided, and medically focused; cognitive behavioral therapy was manual guided and provided for the first 12 weeks of treatment. The primary outcome measures were self-reported frequency of illicit opioid use and the maximum number of consecutive weeks of abstinence from illicit opioids, as documented by urine toxicology and self-report.
The 2 treatments had similar effectiveness with respect to reduction in the mean self-reported frequency of opioid use, from 5.3 days per week (95% confidence interval, 5.1-5.5) at baseline to 0.4 (95% confidence interval, 0.1-0.6) for the second half of maintenance (P<.001 for the comparisons of induction and maintenance with baseline), with no differences between the 2 groups (P=.96) or between the treatments over time (P=.44). For the maximum consecutive weeks of opioid abstinence there was a significant main effect of time (P<.001), but the interaction (P=.11) and main effect of group (P=.84) were not significant. No differences were observed on the basis of treatment assignment with respect to cocaine use or study completion.
Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioral therapy.

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    • "In light of the high rate of relapse that occurs after BMT cessation reviewed here and the high rate of relapse when buprenorphine is used as a detoxification medication (Dunn et al., 2011; Horspool et al., 2008), major improvement in intention-to-treat outcomes might be realized by removal of strict barriers to continued enrollment in BMT. For example, the Drug Addiction Treatment Act of 2000 requires that patients in the United States receiving BMT also receive " appropriate counseling; " however, counseling of any type has not yet been shown to improve outcomes beyond BMT alone (Amato, Minozzi, Davoli, & Vecchi, 2011; Downey, Helmus, & Schuster, 2000; Fiellin et al., 2013; 2006; Ling et al., 2013) and, if too restrictive, may form a barrier to continuing BMT enrollment (Gryczynski et al., 2013). "
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